Hematopoietic cancer and peptic ulcer: a multicenter case-control study

• Published in: Carcinogenesis (New York) 1999-08, Vol.20 (8), p.1459-1464
• Main Authors: Vineis, Paolo, Crosignani, Paolo, Sacerdote, Carlotta, Fontana, Arabella, Masala, Giovanna, Miligi, Lucia, Nanni, Oriana, Ramazzotti, Valerio, Rodella, Stefania, Stagnaro, Emanuele, Tumino, Rosario, Viganò, Clotilde, Vindigni, Carla, Costantini, Adele Seniori
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Case-Control Studies; chronic lymphocytic leukemia; CLL; confidence interval; Educational Status; Female; Gastroenterology. Liver. Pancreas. Abdomen; Helicobacter Infections - complications; Helicobacter pylori; Hematologic and hematopoietic diseases; Hodgkin's disease; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; lymphocytic leukemia; Lymphoma, B-Cell, Marginal Zone - complications; Lymphoma, B-Cell, Marginal Zone - microbiology; Lymphoma, Non-Hodgkin - complications; Lymphoma, Non-Hodgkin - microbiology; Male; Medical sciences; Middle Aged; myeloid leukemia; NHL; non-Hodgkin's lymphoma; Odds Ratio; Other diseases. Semiology; Peptic Ulcer - complications; Peptic Ulcer - microbiology; Risk; Sex Factors; Stomach Neoplasms - complications; Stomach Neoplasms - microbiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
• ISSN: 0143-3334; 1460-2180; 1460-2180
• DOI: 10.1093/carcin/20.8.1459

Helicobacter pylori has been suggested as a cause of gastric carcinoma and gastric non-Hodgkin's lymphoma (NHL). In a previous cohort study, a relative risk of six for gastric NHL was reported among subjects who tested positive for anti-H.pylori antibodies. The association between peptic ulcer and NHL has been studied in a population-based case-control investigation on hemato-lymphopoietic malignancies in Italy, based on face-to-face interviews to 2671 cases and 1718 controls (refusal rates 10 and 19%, respectively). Subjects who reported a diagnosis of peptic ulcer had a relative risk of 5.6 [95% confidence interval (CI) 3.8–8.0] for gastric NHL, whereas the estimate for non-gastric NHL was 1.3 (1.0–1.6). The association with recent diagnosis of ulcer was stronger, but the odds ratio (OR) was as high as 2.1 (95% CI 1.1–4.2) after ≥20 years since such diagnosis. After exclusion of the last 2 years before the diagnosis of NHL, and of ulcers diagnosed before 1978 (when gastroscopy became common in Italy), the OR was still 5.3 (95% CI 3.0–9.2). We found a strong effect modification by educational level, with ORs for ulcer more elevated in higher social groups. Gender was an effect modifier (OR = 4.1 in males, 9.2 in females; P = 0.03 for heterogeneity). The association with other gastrointestinal pathologies was much lower and statistically not significant. Almost all gastric lymphomas were B-cell NHLs of intermediate grade according to the working formulation; the majority belonged to the mucosa-associated lymphoid tissue (MALT) type. The association with ulcer was much stronger among MALT lymphomas, but only for recent ulcer diagnoses (2–10 years). Our study shows an increased risk for gastric NHL, very similar to the estimate reported in a previous cohort study. The risk was higher among more educated subjects.